Buscar en
Endocrinología y Nutrición
Toda la web
Inicio Endocrinología y Nutrición Papel del flúor en la osteoporosis
Información de la revista
Vol. 51. Núm. 7.
Páginas 426-432 (Agosto 2004)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 51. Núm. 7.
Páginas 426-432 (Agosto 2004)
Acceso a texto completo
Papel del flúor en la osteoporosis
Role of fluor in osteoporosis
Visitas
9920
D.A. De luis Román
Autor para correspondencia
Dadluis@yahoo.es

Correspondencia: D.A. de Luis Román. Director Instituto de Endocrinología y Nutrición. Perales, 16. 47130 Valladolid. España
, R. Aller de la Fuente, J. De Luis, J.L. Pérez, M. González
Instituto de Endocrinología y Nutrición. Facultad de Medicina. Valladolid. Unidad de apoyo a la investigación. Hospital Universitario Río Hortega. Valladolid. España
Este artículo ha recibido
Información del artículo

Fluor is a salt present in our body in a small amount (mg). Fluor and parathormone are the only currently available options for increasing bone formation. The aim of this article was to review the studies analyzing the utility of fluor in the treatment of osteoporosis. A search was performed of the MEDLINE database using the key terms fluor and osteoporosis. Because of the variety of designs of these studies and the type and dose of salt used, firm conclusions cannot be reached. To date, only one metaanalysis has been performed, which included 11 studies with 1429 patients and a 4-year follow-up of treatment with fluor, with comparison of fluor as monotherapy with placebo. An increase of spinal bone mass in the group receiving fluor treatment was detected at 2 years (8.1%) and at 4 years (16.1%). The relative risk of new vertebral fractures was not significant at 2 years (0.87 [0.51-9.09]) or at 4 years (0.9 [0.71-1.14]). The relative risk for new nonvertebral fractures was not significant at 2 years (1.2 [95% CI: 0.68-2.1) but was increased at 4 years (1.85 (95% CI: 1.36- 2.5]). Gastrointestinal side effects were similar at 2 years (2.18 [95% CI: 0.86-1.21]) but were increased at 4 years (2.18 [95% CI: 1.69-4.57). Although fluor could be useful in the treatment of osteoporosis, there is a multitude of articles with different designs that do not provide answers to questions such as the differences between fluor and biphosphonates, and the dose and type of fluor salt that should be used.

Palabras clave:
Flúor
Osteoporosis
Revisión
Key words:
Fluor
Osteoporosis
Review

El fluoruro es un ion presente en el cuerpo en cantidades muy pequeñas, en el orden del miligramo. El flúor y la paratirina (PTH) son los únicos tratamientos de los que disponemos en la actualidad con capacidad para estimular la formación ósea. Nos proponemos revisar los trabajos existentes en que se analiza la utilidad del flúor en el tratamiento de la osteoporosis, utilizando como términos claves flúor y osteoporosis en la base de datos Medline. La heterogeneidad de diseño en los estudios, el tipo y la dosis de la sal de flúor utilizada no permiten extraer conclusiones claras. Hasta la fecha sólo existe un metaanálisis, donde se analizan 11 estudios con 1.429 pacientes, con un seguimiento de 4 años, donde se comparó el flúor como monoterapia frente a placebo. Como conclusiones se obtuvieron que el incremento de la masa ósea espinal fue superior en el grupo tratado con flúor tanto a los 2 (8,1%) como a los 4 años (16,1%). El riesgo relativo para nuevas fracturas vertebrales no fue inferior ni a los 2 años (0,87 [intervalo de confianza {IC} del 95%, 0,51- 9,09]) ni a los 4 años (0,9 IC del 95%, 0,71-1,14]). El riesgo relativo de nuevas fracturas no vertebrales no fue inferior a los 2 años (1,2 [IC del 95%, 0,68-2,1]) pero sí fue superior a los 4 años (1,85 [IC del 95%, 1,36- 2,5]). Los efectos secundarios gastrointestinales no fueron superiores a los 2 años (riesgo relativo = 2,18 [IC del 95%, 0,86-1,21]) pero sí a los 4 años (riesgo relativo = 2,18 [IC del 95%, 1,69-4,57]). Por tanto, aunque parece que el flúor puede ser útil en el tratamiento de la osteoporosis, hay multitud de trabajos con diferentes diseños en que todavía no se ha conseguido contestar a preguntas como las posibles diferencias con los bisfosfonatos, la dosis y tipo de sal de flúor que se debe utilizar.

El Texto completo está disponible en PDF
Bibliografía
[1.]
C. Rich, J. Ensinck.
Effect of sodium fluoride on calcium metabolism of humans beings.
Nature, 191 (1961), pp. 184-185
[2.]
M. Gambacciani, A. Spinetti, F. Taponecao, L. Piaggesi, B. Cappagli, M. Ciaponi, et al.
Treatment of postmenopausal vertebral osteopenia with monofluorophosphate: a long-term calciumcontrolled study.
Osteoporos Int, 5 (1995), pp. 467-471
[3.]
D.J. Baylink, P.B. Duane, S.M. Farley, J.R. Farley.
Monofluorophosphate physiology: the effects of fluoride on bone.
Caries Res, 17 (1983), pp. 56-76
[4.]
P. Affinito, C. Di Carlo, M. Primizia, G. Petrillo, V. Napolitano, F. Tremolaterra, et al.
A new fluoride preparation for the prevention of postmenopausal osteoporosis: calcium plus monofluorophosphate.
Gynecol Endocrinol, 7 (1993), pp. 201-205
[5.]
M. Mamelle, R. Dusan, J.L. Martin.
Risk benefit ratio of sodium floride treatment in primary vertebral osteoporosis.
Lancet, 13 (1988), pp. 361-365
[6.]
C.Y.C. Pak, K. Sakhaee, J.E. Zerwekh, C. Parcel.
Safe and effective treatment of osteoporosis with intermitent slow release fluoride: augmentation of vertebral bone mass and inhibition of fractures.
J Clin Endocrinol Metab, 68 (1989), pp. 150-159
[7.]
P.D. Demas, J. Dupuis, F. Duboeuf, M.C. Chapuy.
Treatment of vertebral osteoporosis with disodium monofluorophosphate: comparison with sodium fluoride.
J Bone Miner Res, 5 (1990), pp. S143-S147
[8.]
C. Nagant, J.P. Devogelaer, G. Depresseux, J. Malghem, B. Maldague.
Treatment of the vertebral crush fracture syndrome with enteric coated sodium fluoride tablets and calcium supplements.
J Bone Miner Res, 5 (1990), pp. S5-S26
[9.]
B.L. Riggs, S.F. Hodgson, W.M. Ofallon, E.Y.S. Chao, H.W. Wahner, J.M. Muhs.
Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis.
N Engl J Med, 322 (1990), pp. 802-809
[10.]
M. Kleerekoper, E.L. Peterson, D.A. Nelson, E. Philips, M.A. Schork, B.C. Tilley.
A randomized trial of sodium fluoride as a treatment for postmenopausal osteoporosis.
Osteoporosis Int, 1 (1991), pp. 155-161
[11.]
B.L. Riggs, W.M. Ofallon, A. Lane.
Clinical trial of fluoride therapy in postmenopausal osteoporotic women: extended observations and additional analysis.
J Bone Miner Res, 9 (1994), pp. 265-275
[12.]
D. Thiebaud, P. Burckhardt, J. Melchior, P. Ekckert.
Two years effectiveness of intravenous pamidronate vs oral fluoride for osteoporosis occuring in the postmenopause.
Osteoporosis, 4 (1994), pp. 76-83
[13.]
C.Y.C. Pak, K. Sakhaee, V. Piziak, R.D. Peterson.
Slow release sodium fluoride in the management of postmenopausal osteoporosis.
Ann Int Med, 120 (1994), pp. 625-632
[14.]
J.L. Sebert, P. Richard, I. Mennecier.
Monofluorophosphate increases lumbar bone density in osteopenic patients: a double blind masked randomized study.
Osteoporos Int, 5 (1995), pp. 108-114
[15.]
R. Rizzoli, T. Chevalley, D.O. Slosman.
Sodium monofluorophosphate increases vertebral bone mineral density in patients with corticosteroid induced osteoporosis.
Osteoporos Int, 5 (1995), pp. 39-46
[16.]
W.F. Lems, J.W.G. Jacobs, J.W.J. Bijlsma.
Van Veen GJM. Is addition of sodium fluoride to cyclical etidronate beneficial in the treatment of corticosteroid induced osteoporosis.
Ann Rheum Dis, 56 (1997), pp. 357-363
[17.]
W.F. Lems, J.W.G. Jacobs, J.W.J. Bijlsma, A. Croone.
Effect of sodium fluoride in the prevention of corticosteroid induced osteoporosis.
Osteopororos Int, 7 (1997), pp. 575-582
[18.]
J.Y. Reginster, L. Meurmans, B. Zegels, L.C. Rovati, H.W. Minne, G. Giacovelli.
The effect of sodium monofluorophosphate plus calcium on vertebral fracture rate in postmenopausal women with moderate osteoporosis.
Ann Int Med, 129 (1998), pp. 1-8
[19.]
P.J. Meunier, J.L. Sebert, J.Y. Reginster, D. Briancon.
Fluoride salts are no better at preventing new vertebral fractures than calcium vitamine D in postmenopausal osteoporosis: The FAVO Study.
Osteoporos Int, 8 (1998), pp. 4-12
[20.]
J.D. Ringe, A. Dorst, C. Kipshoven, L.C. Rovati.
Avoidance of vertebral fractures in men with idiopathic osteoporosis by a three year therapy with calcium and low-dose intermitent monofluorophosphate.
Osteoporos Int, 8 (1998), pp. 47-52
[21.]
J.D. Ringe, C. Kipshoven, A. Coster.
Therapy of established postmenopausal osteoporosis with monofluorophosphate plus calcium: dose related effects on bone density and fracture rate.
Osteoporos Int, 9 (1999), pp. 171-178
[22.]
P. Alexandersen, B.J. Riis, C. Christiansen.
MFP combined with hormone replacement therapy induces a synergistic effect on bone mass by dissociating bone formation and resorption in postmenopausal wome: a randomized study.
J Clin Endocrinol Metabol, 84 (1999), pp. 3013-3020
[23.]
N. Guañabens, J. Farrerons, L. Perez Edo, J. Carbonell, M. Roca, M. Torra, et al.
Cyclical etidronate vs sodium fluoride in established postmenopausal osteoporosis: a randomized 3 year trial.
Bone, 27 (2000), pp. 123-128
[24.]
C.D. Rubin, C.Y.C. Pak, B. Adams Huet.
Sustained release sodium fluoride in the treatment of elderly with established osteoporosis.
Arch Intern Med, 161 (2001), pp. 2325-2333
[25.]
D.H. Gutteridge, G.O. Stewart, R.L. Prince, R.W. Retallack, S.S. Dhaliwal.
Stuckey BGA. A randomized trial of sodium fluoride ± increased vertebral fractures and peripheral bone loss with sodium fluoride estrogen in postmenopausal osteoporotic vertebral fractures: concurrent estrogen prevents peripheral loss, but not vertebral fractures.
Osteoporos Int, 13 (2002), pp. 158-170
[26.]
J.D. Ringe, I. Setniker.
MFP combined with hormone replacement therapy in postmenopausal osteoporosis. An open label pilot efficacy and safety study.
Rheumatol Int, 22 (2002), pp. 27-32
[27.]
V. Abitbol, J.Y. Mary, C. Roux.
Osteoporosis in inflamatory bowel disease: effect of calcium and vitamin D with or without fluoride.
Aliment Pharmacol Ther, 16 (2002), pp. 919-927
[28.]
D. Haguenauer, V. Welch, P. Tugwell, J.D. Adachi, G. Wells.
Fluoride for the treatment of postmenopausal osteoporotic fractures: a metaanalysis.
Osteoporos Int, 11 (2000), pp. 727-738
[29.]
American Association of Clinical Endocrinologists.
Osteoporosis Task Force.
Endocr Pract, 7 (2001), pp. 293-312
[30.]
Pak CYC.
A new perspective on fluoride therapy.
Osteoporosis, 2 (2001), pp. 670-699
Copyright © 2004. Sociedad Española de Endocrinología y Nutrición
Opciones de artículo
Herramientas
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos